6/8/2009

Matt Bai has a lengthy piece in The New York Times Magazine, detailing the myriad ways in which Pres. Obama, Vice Pres. Biden and WH Chief of Staff Rahm Emanuel are getting more directly involved in their proposed government takeover of the healthcare system. Biden and Emanuel have been involved below the radar for some time already, but there is also this Sorkin-esque nugget:

Of all the assets the White House has at its disposal, of course, none are more valuable than a three-dimensional president with a 60-plus-percent approval rating. Emanuel and I had been talking for just a few minutes when his office door suddenly burst open and the president strode in. I hadn’t seen Obama since interviewing him last September on the day when the stock market crashed (John McCain crashed soon after), so I congratulated him belatedly, and he chatted amiably for a few minutes, appearing entirely untroubled in the midst of the myriad crises facing his administration. Fumbling clumsily to button my suit coat as I stood in his presence, I was reminded of how different it is to talk with someone who has actually assumed the historical weight of the presidency, even if you’ve spoken with him before. Emanuel knows this phenomenon is as real for senators and congressmen as it is for reporters, which is why he choreographs the same kind of “spontaneous” drop-bys when members comes to see him. “I’ll have a lunch here, and he’ll come by to say hi to Susan Collins the way he came by to see you,” Emanuel told me after Obama departed, referring to the senator from Maine. “It’s an efficient use of his time.”

Is it? Robert Reich passes along some juicy tidbits to the contrary about Maine’s other “moderate” Senator:

Enter Olympia Snowe. Her move is important, not because she’s Republican (the Senate needs only 51 votes to pass this) [That remains to be seen –K] but because she’s well-respected and considered non-partisan, and therefore offers some cover to Democrats who may need it. Last night Snowe hosted a private meeting between members and staffers about a new proposal Pharma and Insurance are floating, and apparently she’s already gained the tentative support of several Democrats (including Ron Wyden and Thomas Carper). Under Snowe’s proposal, the public option would kick in years from now, but it would be triggered only if insurance companies fail to bring down healthcare costs and expand coverage in he meantime.

What’s the catch? First, these conditions are likely to be achieved by other pieces of the emerging legislation; for example, computerized records will bring down costs a tad, and a mandate requiring everyone to have coverage will automatically expand coverage. If it ever comes to it, Pharma and Insurance can argue that their mere participation fulfills their part of the bargain, so no public option will need to be triggered. Second, as Pharma and Insurance well know, “years from now” in legislative terms means never. There will never be a better time than now to enact a public option. If it’s not included, in a few years the public’s attention will be elsewhere.

Much the same dynamic is occurring in the House… (Emphasis added.)

Similarly, we have already seen House Majority Leader Steny Hoyer suggest there is little support for handing the Medicare Payment Advisory Commission the power to come up with recommendations to control costs with little input from Congress. This was going to be Obama’s backdoor way for voting “present” on all of those unpopular decisions to ration medical treatment that would follow from a government-dominated healthcare system. And this is before Obama’s bill has had a chance to be digested by the public, with the inevitable troublesome details that will emerge. Moreover, as Bai’s piece points out:

THE NETTLESOME THING about leaving the details of the health care plan to Congress, though, is that this Congress, like most every other Congress, doesn’t appear inclined to pay for much of anything. And it is this part of the health care debate — where to find the money — that seems most likely to derail the process.

This has been obvious for a while, but it always bears repeating, especially to readers of The New York Times. The Obama administration has studied the Clintons’ failure to take over American medicine, and is pursuing a different Congressional strategy. But Congress remains Congress.

22 Responses to “Will Olympia Snowe derail Obamacare?”

For all their talk about “studying” the Clinton’s Waterloo regarding healthcare, they sure appear to be quite tone – deaf on the issue so far. We hear about Rahm basically screaming epithets at anyone in Congress who opposes their plans (surprise!), while Obama’s already backpedalling furiously on the stimulus package, yet they think they can shove another monstrosity through? I think Congress is about to show him who’s exactly in charge of the nation’s finances from now on, and it ain’t him – if they pass this thing they’ll lose their majorities next year, and they know it.

It seems that the O!ne should have spent his political capital on this, rather than the spendulus bill and his bloated budget; if he was actually serious about it…

But now, with his popularity and approval ratings beginning to slip, and the public tiring of excessive spending, it seems as though the congressional types are providing him political cover, in the way of providing him the opportunity to vote “present” (a particularly apropo and amusing characterization, Karl), while protecting their phony-baloney jobs with a public that at least expects the appearance of fiscal responsibility…

“But critics argue that with low administrative costs and no need to produce profits, a public plan will start with an unfair pricing advantage. They say that if a public plan is allowed to pay doctors and hospitals at levels comparable to Medicare’s, which are substantially below commercial insurance rates, it could set premiums so low it would quickly consume the market.”

And I thought that was the idea.

The Republican party: the party of monopolies, as long as they’re private.

I have known 3 Goolsbees in my time. None of them were to be trusted. Austan fits that mold. Sorry. If he told the Canadians on thing and us another and he works for this administration I have no good use for him.

Good thing Obama’s plan doesn’t mandate people purchase insurance coverage or pay a penalty to be determined based on affordability by the government, because that would be equivalent to a tax and Obama said he was going to cut taxes for 95% of people and not raise any new ones, right.

The way to reform healthcare is by gradually moving from employer based to fund based, sort of like CALPers. This is the French system. They lost a war, which gave them a chance to reform in a big jump but the government did not blow up the existing system. Doctors and hospitals are largely private and patients have free choice.

The thing that killed the Clinton plan, which was supposed to have been based on the German system, was the secrecy and the criminal penalties that leaked out. The group doing the planning was made up of academics, many from Dartmouth. Obama’s entire administration is made up of academics so I expect a similar crash and burn although this time it will be the entire economy.

I cannot believe that this will finally be swallowed but the AMA has been in bed with the feds since the late 80s. Hugh Hewitt is talking about boutique medicine. That is one option but they may not allow it. The Clinton Plan didn’t. Instead what we may see is massive drop out. I could see doctors going largely private and a cash basis with hospitals still dealing with insurance. The poor would still use insurance and there would be a class of doctors who accept insurance, just as there is a class of doctors that deal with workers comp and with Medicaid.

I deal with the workers comp group every day on the phone. Many are honest and just trying to do a good job. Most of these see few workers comp patients. There are also the mills and I suspect we will see (assuming Obamacare happens) a similar pattern with private doctors treating patients willing to pay privately, then another group that will abide by the rationing and the rules of the Obama plan.

[...] trade-offs. Ultimately, they are unlikely to get meaningful support from the GOP (and I include Sen. Olympia Snowe in that statement). House Leftists threaten to kill a bill that does not include a strong [...]

[...] Sen. Snowe has pushing the notion of a “public option with trigger” for months, and it has been the Left expressing dismay over the idea. True believers like Robert Reich say Snowe is fronting for Big Pharma and health insurers, with conditions that would be easily met by other pieces of the emerging legislation. Rahm Emanuel has been floating the trigger idea since January, again to the dismay of lefty groups like MoveOn. The left notes that congressional Republicans crafted a similar trigger for the Medicare prescription-drug benefit in 2003 — and it has never been triggered. For the left, the “public option” deferred is the “public option” denied. [...]

[...] about it. But Karl at Protein Wisdom thinks there could be a silver lining in this new tactic: Sen. Snowe has pushing the notion of a “public option with trigger” for months, and it has been the Left expressing dismay over the idea. True believers like Robert Reich say [...]

[...] 1600 Penn. More broadly, the White House, especially Chief of Staff Rahm Emanuel, have been for the “public option with trigger” for months — which is why the usual lefty suspects are protesting now, and why the story [...]